Palmoplantar psoriasis

Palmoplantar psoriasis can exist alone in the absence of other typical psoriatic lesions.
Red plaques are typically surmounted by a compact to micaceous scale. Fissuring may be present. Pustules, and occasionally vesicles, may be evident.
Palmoplantar psoriasis is a debilitating condition which can significantly compromise quality of life. Exacerbating factors include, as with all psoriasis, trauma.

Treatment:

• Palmoplantar psoriasis is quite resistant to treatment.
• Topical glucocorticoids, such as the most potent agent clobetasol 0.05 % ointment bid, are the mainstay of treatment.
• If patients fail to respond to this, PUVA of the hands and feet is often effective.
• Short term oral cyclosporine 2-5 mg/kg is indicated for severe involvement.
• Methotrexate 5 mg q 12 hrs, for 3 doses, once a week is also useful in recalcitrant disease, but the use of these systemic agents though should be restricted to those patients whose quality of life is truly very seriously compromised.

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